Publications

INTRODUCTION: Periods of civil unrest pose significant operational and security challenges to those seeking to provide emergency care to patients. For emergency departments (EDs) and their staff, effectively operating in this potentially hostile environment requires careful planning. Understanding the challenges posed during periods of civil unrest is paramount for emergency medicine staff and emergency planners to ensure continuity of care.

OBJECTIVE: To provide ED and hospital staff with an understanding of the challenges faced during periods of civil unrest and to offer recommendations to maintain safety and operational viability.

DISCUSSION: Preplanning before any anticipated civil unrest is essential to a well-coordinated response. During the period of civil unrest, maintaining effective communication between command elements and clinicians in the ED is vital to ensure bidirectional sharing of information. Deviations from normal operating procedures should be expected and relayed to clinicians as quickly as possible. Similarly, staff may need to shelter in place or relocate to a more secure area within the hospital. Civil unrest is highly dynamic, and hospital leadership must follow developments closely to protect staff and facilities.

CONCLUSION: This review provides ED and hospital staff with an understanding of the significant challenges during periods of civil unrest.

Computer simulation modeling provides significant value in enhancing emergency preparedness policies for schools, businesses, and outdoor events. This is especially true for complex and unpredictable events like active shooter scenarios, which are difficult to physically replicate due to their diversity in terms of circumstances, venues, and challenges. Active shooter events can occur under various circumstances and take place in a wide range of venues including schools, offices, and outdoor events and create a wide range of unique challenges. According to a 2017 study, 15 percent of human-caused mass casualty incidents with over 10 fatalities are mass shootings. Therefore, our work focused on adding injury type, blood loss related to the function of placement of gunshot wounds, and time lapse from injury. These additional parameters significantly improve active shooter event simulation and changes the paradigm established by currently available simulations where the victims are either "killed" or "unaffected." This traditional binary approach is unsuitable when the timeliness of interventions is of concern and does not help improve emergency preparedness and emergency response protocols. In a previous work, the authors demonstrated how simulating physiological decline can be quantified, improve realism, and lead to response protocol improvement. The current work proposes a model for simulated mitigation of gunshot wound injuries, which complements the previously presented exsanguination model. To simulate injury and blood loss mitigation, a number of data sources were consulted to quantify the blood outflow and how it can be limited by different measures, as well as the time required to apply them and their individual effectiveness. This work summarizes the findings and provides a practical guide for implementation. In an additional work, the authors provide a reference implementation in a software library for AnyLogic®. That research focused on the simulation of the initial injury, its mitigation, and the time for critical care transport during the proverbial golden hour of trauma. The human body is complex; the circulatory system alone has several compensatory mechanisms and a wide range of variability in every organism. In addition, the way it responds to coagulating agents and other blood loss control techniques may vary between different organisms and humans. In this work, the authors focus on the primary effectors of those variables and introduce a limited set of mitigations for a relatively short-term simulation. While the model is imperfect, it creates a common ground for further simulation work where different researchers can converge on a known unified deterministic model, allowing them to control that variable while testing hypotheses about other parts of the emergency response. Furthermore, by increasing fidelity, this model can help assess the effects of bystander volunteer hemorrhage control, medical first response, and critical care transport times.

This research analyzes the content and performance of the public relations tactic of press conferences published on the World Health Organization's YouTube® channel during the coronavirus disease 2019 pandemic. This study examined 3,506 videos-focusing on 142 press conferences published between May 27, 2020, and May 5, 2023-and their audience impact and engagement correlations. In contrast, nonpress conference videos, spanning from the channel's inception up to the data collection date (March 16, 2024), were analyzed as a benchmark for evaluating the performance of press conferences. Moreover, the 13 most-viewed press conferences were qualitatively analyzed using framing theory to determine their dominant frames and sentiments. The analysis revealed that audiences who perceive a risky situation are willing to watch longer videos, post more comments than on other videos, and emit negative or neutral frames when they feel gaps in the official information.

This study highlights spatial responses and displacements following Hurricane Michael by analyzing X® (formerly known as Twitter) data across various states in the United States over a multitude of periods, regions, and demographic characteristics. This study finds that the top three states damaged by the hurricane (Florida, Georgia, and North Carolina) show a significantly higher proportion of tweets during the hurricane week than the prehurricane and post-hurricane weeks. Furthermore, people's responses on social network services have some similar and dissimilar characteristics compared to the census data. For instance, Hispanics show significantly low responses to the hurricane event in all the three states compared to other races/ethnicities, as reflected in the census data. Finally, the gender and region variables play an important role in displacements within the binary logistic regression model, whereas the race/ethnicity and age variables are not related to displacements. To be specific, females show 0.4 times more displacements than males, and Georgia and North Carolina exhibit 1.3 and 0.8 times more displacements than Florida.

Environmental disasters are inherently political phenomena, shaped by systemic inequalities and entrenched power dynamics. This article analyzes how the securitization paradigm and slow violence frameworks explain the disproportionate impact of Hurricane Katrina on marginalized communities. While the territorial securitization paradigm focuses on reactionary military preparedness, it fails to address the long-term systemic issues-such as racism, socioeconomic inequality, and inadequate -infrastructure-that exacerbate vulnerability to environmental events. Using qualitative case study analysis, this article draws on federal reports, congressional records, academic literature, and media sources to examine structural neglect and racialized disaster response, and it draws parallels between Hurricanes Katrina and Maria. The disproportionate impact of Katrina on New Orleans' Black and low-income communities underscores the intersection of structural violence, slow violence, and environmental vulnerability. By reframing environmental security within the context of systemic inequities, this article calls for a renewed focus on resilience-building measures and inclusive disaster planning to address the root causes of vulnerability and mitigate future disasters.

The critical importance of access to water has been recognized both nationally and internationally. In the United States, the National Infrastructure Protection Plan and other planning documents highlight the potentially dire public health implications of impacts on public water systems. According to the Fifth National Climate Assessment, safe and reliable potable water supplies are at risk due to climate change, flooding, drought, and sea level rise, and such risks are expected to increase going forward. Internationally, the Sustainable Development Goals include ensuring availability and sustainability of water and sanitation. Despite this fact, acute shocks and long-term stressors may cause contamination or otherwise limit access to safe drinking water. The Federal Emergency Management Agency's Community Lifelines approach encompasses access to water and other necessities, and requires emergency managers to take a whole-community approach to response and recovery. However, preparedness and mitigation efforts have not historically taken this same approach. Recent water crises, such as the ones in Flint, Michigan, and Jackson, Mississippi, have shown a disconnect between water system managers and emergency managers. Inclusive emergency management demands consideration of both current and future needs, and consideration of Community Lifelines, regardless of the circumstances surrounding the adverse event. The recent saltwater intrusion threat along the lower Mississippi River in southeast Louisiana has provided yet another example of vulnerability in the drinking water sector and the intersection of emergency management and public health.

Flooding is the deadliest and most damaging natural hazard worldwide. Despite efforts to make communities more flood-resilient, global flood impacts are on the rise due to ongoing climate change. Amid the expected increase in the intensity and frequency of flood disasters, there is an urgent need to understand the roles of network governance in ensuring coordinated efforts in response to floods. The goal of this study is to examine interorganizational coordination and collaboration in the aftermath of the New South Wales (NSW) Floods in Australia in 2022. Specifically, this study addresses two primary research questions: (1) Which agencies coordinated and collaborated during the response to the NSW Floods? (2) What were the characteristics of the interorganizational coordination system in response to the NSW Floods in 2022? This study uses Natural Language Processing techniques to extract relevant information from the NSW Government (2022) Flood Inquiry Report and the NSW Legislative Council Report (2022) to answer the research questions. The findings indicate that several agencies played a critical coordinating role and collaborated during the response to the NSW Floods. In addition, the analysis of the collaborative networks indicates strong connections between certain entities and weak or absent connections among other entities in the response network. These results provide valuable insights into the relationships and thematic focus of flood-related policies in Australia and underscore the need for enhanced collaboration and coordination among key stakeholders, including government agencies, to ensure a unified and effective approach to flood resilience.

Anxiety and depression are common in prostate cancer (PCa) patients and negatively impact the quality of life, treatment outcome, survival and overall well-being, thus, requiring interventions to meet the psychosocial needs of PCa patients across treatment stages. However, there is not enough information to guide the design of these interventions, as there are still areas of lack of clarity regarding the prevalence and predictors of anxiety and depression in PCa patients. Therefore, this review was conducted to examine the literature to identify the overall prevalence of anxiety and depression across treatment stages in PCa patients and to identify the predictors of anxiety and depression in this population. A literature search was conducted from the Cochrane library, Ovid Medline and APA PsycINFO databases. Eighteen eligible studies were included in the final review. The findings were analysed using a narrative synthesis. The study quality was assessed using the Joanna Briggs Institute critical appraisal checklist. The prevalence of anxiety and depression was found to be between 6% to 44.8% and 10% to 48%, respectively. Notably, the prevalence of depression was higher in the post-treatment phase than in the treatment phase. Finally, the result demonstrates that socio-economic/demographic, clinical and lifestyle factors determine patients' predisposition to anxiety and depression. These demonstrate that the prevalence of anxiety and depression is high across the PCa disease trajectory and that some patients are more likely to experience anxiety and depression than others. Therefore, we recommend periodic assessment to identify at risk patients and those with clinically significant or worsening levels of anxiety and depression for timely interventions to mitigate the risks or ameliorate the symptoms of anxiety and depression.

Cancer burden is expected to increase in the next decades, especially in low- and middle-income countries (LMICs). There, including in Portuguese-speaking African countries, cancer care remains fragile and highly centralised. Global ONCOlogy Initiative (GONCO) is a pragmatic initiative launched in Portugal to support the development of decentralised oncology services through short, targeted interventions. This paper presents its conceptual design and the first two pilot projects, implemented in Lubango (Angola) and Mindelo (Cape Verde). GONCO follows a three-step model: digital planning, fieldwork and digital follow-up. In both sites, the program was co-developed with local teams and focused on establishing multidisciplinary tumour boards, improving service coordination and building capacity in clinical management, protocols and research. In Lubango, GONCO helped launch the oncology unit and research group. In Mindelo, it supported service restructure planning and the creation of a breast cancer working group. Remote collaboration sustained momentum after field visits. Challenges included hierarchical barriers, unreliable digital infrastructure and non-sustainable funding. Despite these, GONCO demonstrated that focused and adaptable models can catalyse oncology development in resource-constrained hospitals. GONCO provides a replicable, light-footprint model for early oncology development in LMICs.